How Does ZeroSole Redistribute Pressure?

Key Points

• ZeroSole redistributes pressure by removing individual hexagonal cells beneath a focal pressure point to create a targeted offloading cavity.
• The pressure point is identified, the corresponding cells are removed, and the patient’s response is assessed while standing and walking.
• The size and position of the pressure point should guide how many cells are removed.
• Pressure-mapping research found an average of 32% reduction in peak plantar pressure when ZeroSole was customised for targeted offloading.

Why is targeted offloading useful?

Targeted offloading can reduce pressure in a specific area where repeated mechanical loading contributes to pain or a pressure-related lesion.

In practice, patients may present with corns, calluses or other areas of localised pressure associated with joint deformities, bony prominences or repetitive mechanical load.

The appropriate intervention depends on the individual presentation. Temporary padding can be useful in some situations, while more complex deformities or functional changes may require fully bespoke or correctional/functional orthotic treatment.

ZeroSole was designed to sit between these approaches, providing a practical first-line offloading option that can be customised during a routine appointment or domiciliary visit.

How does ZeroSole create a targeted offload?

ZeroSole creates an offloading cavity by removing individual hexagonal cells beneath the area requiring pressure reduction, while the surrounding cells remain in place.

The process can be approached in three steps:

1. Identify

Identify the area requiring offloading based on the clinical presentation, such as a visible lesion, tenderness, local inflammation or a structural or functional change.

A transfer sticker (included in the pack) can then be used to mark the relevant position on the insole, helping to identify where the corresponding cells need to be removed.

2. Customise

Remove the corresponding hexagonal cells to create an appropriately sized cavity beneath the pressure point.

The number of cells removed should reflect the size and position of the area requiring offloading.

3. Assess

Have the patient stand and walk in the customised insole to assess their response.

Functional additions, such as metatarsal domes, can also be incorporated where appropriate (not included). 

How many cells should be removed?

The number of cells removed should reflect the size and position of the area requiring offloading.

For example, where a lesion is less than 1cm and sits directly over a single hexagonal cell, removing one cell would be the best starting point.

If the lesion is larger than 1cm or spans across multiple cells, you may need to remove additional cells to create an appropriately sized offloading area.

The aim is not simply to remove more cells, but to create an offloading area appropriate to the individual pressure point. 

If in doubt, it is better to remove fewer cells initially, as you can reassess and remove more cells at follow-up appointments if required. 

Here are some example offload configurations: 

What does the research show?

Research into ZeroSole has examined both pressure redistribution and its clinical use for painful plantar lesions.

Independent pressure-mapping research found an average of 28% reduction in peak plantar pressure when ZeroSole was customised to create a targeted offloading cavity.

The research used high-resolution in-shoe pressure mapping to assess the effect of removing cells and creating a targeted offloading area.

A separate six-week clinical evaluation by Cardiff Metropolitan University assessed ZeroSole alongside usual care for painful plantar lesions, including corns and calluses. The evaluation found an immediate reduction in pain following fitting, alongside a clinically significant reduction in lesion size over the six-week period.

Together, these findings support the pressure-reducing effect of targeted offloading and its use alongside usual clinical care.

How does ZeroSole compare with other offloading options?

Different offloading approaches have different clinical applications, and the appropriate option depends on the individual patient and cause of pressure.

Semi-compressed felt can provide a useful short-term option but compresses with repeated weight-bearing. Silicone putty can be particularly useful for custom moulding around digital areas, while correctional and fully bespoke orthoses may be more appropriate where greater correction or support is required.

ZeroSole provides another option where a targeted, chairside-customisable approach is appropriate.

Designed for practical chairside offloading

ZeroSole was designed to give clinicians a straightforward way to create targeted offloading during a routine appointment.

The modular design allows the offloading area to be adapted to the individual pressure point, with the patient's response assessed while standing and walking.

The aim is to provide a practical option between temporary padding and more complex orthotic solutions, without requiring specialist equipment such as glue stations, heat guns or grinders.

Discover ZeroSole for your practice

To learn more about using ZeroSole in clinical practice, contact the ZeroSole team.